自发性食管破裂的外科治疗

目的探讨自发性食管破裂的早期诊断和及时正确的外科治疗以提高自发性食管破裂的治愈率。方法回顾性分析1989年2月至2008年6月收治的56例食管破裂患者临床资料及治疗经过,比较保守治疗与手术治疗的疗效和死亡率,24h内手术治疗与24h以上手术治疗的疗效和死亡率。结果56例自发性食管破裂患者中手术治疗的治愈率是81%,优于保守治疗的50%,P0.05;发病后24h内手术者91%治愈,24h以上手术者66%治愈,P0.05。结论自发性食管破裂早期诊断和早期手术治疗是提高治愈率的关键。     

自发性食管破裂的早期诊断

自发性食管破裂是指非创伤、器械、异物或医源性等原因引起的食管全层破裂,本病发病急骤,容易误诊,如处理不当病死率高,现将我院近期收治的2例报告如下.     

自发性食管破裂的诊断和治疗

自发性食管破裂,又称Boerhaave综合征,是临床上一种严重的胸科急症,因临床少见且易与其他疾病,如急性心肌梗死、消化性溃疡穿孔、急性胰腺炎等混淆,临床诊断较困难,死亡率高。本病的治疗各家纷说不一,早期诊断对其预后有重要意义。随着新技术的不断发展,内镜治疗起重要作用。目前对本病的报道多以一个或多个病例为主,对该病系统的归纳和总结较少见。本文对自发性食管破裂的诊断和治疗作一综述,旨在提高其临床诊治水平。     

自发性食管破裂的诊断及治疗进展

自发性食管破裂(SER),即Boerhaave综合征(BS),系指健康人突然发生非外伤性的食管壁全层破裂。SER为较少见的急性胸部疾患,常易误诊或延误治疗,严重危及生命,是致死频率较高的胃肠道穿孔性疾病之一。随着内镜技术的发展,此病治疗模式正在转变。此文拟就SER的发病机制、临床表现及治疗进展作一综述。     

自发性食管破裂的诊断及外科治疗进展

自发性食管破裂(Boerhaaves综合症)是一种严重的胸部急性疾病,其发病率低,发展迅速,易误诊,病死率高.近年来有关其诊断和外科治疗方法的报道较多,也取得了一些进展,现综述如下.     

自发性食管破裂合并脓胸的外科治疗分析

自发性食管破裂发病急、病情重、病状特异,早期（从食管破裂至就医72h）易误诊,对晚期（超过72h）自发性食管破裂合并脓胸的外科治疗,采用何种术式,目前尚有争议。1993年7月—2009年10月共收治自发性食管破裂合并脓胸患     

自发性食管破裂6例

我院收治自发性食管破裂6例,结合文献259例进行复习,报告如下。 1 对象和方法 1.1 对象 本组6例均为男性,年龄40—56岁,平均45.5岁;文献组259例中男246例,女13例。年龄1.5—75岁。本组发病至就诊时间最短2h,最长6d;文献组就诊时间最短3h,最长达1年。本组6例均因酗酒后呕吐所致。文献组记录详细的246例患者中240例有呕吐史,余6例分别为     

自发性食管破裂（附9例报告）

自发性食管破裂又称为Boerhaave综合征，是一种严重的致命性疾患。该病临床罕见，易误诊误治，其病死率高达11％～100％。我们共收治9例自发性食管破裂患者，7例治愈，2例死亡，现报告如下，以提高对该病的认识。9例患者男7例，女2例；年龄21～64岁，平均32．5岁。9例患者的主要临床资料见附表。讨论自发性食管破裂最常见的原因是剧烈呕吐。呕吐时腹内压力突然增加，致食管内压急剧上升，引起食管薄弱处和结构异常部位破裂穿孔。自发性食管破裂多发生在邻近取上的下段食管，且为纵形，破裂长度以0．5～15cm不等．自发性食管破裂最常见的症…     

食管自发性破裂的手术麻醉体会

自发性食管破裂是指食管内压突然快速增高而造成食管壁全层完全破裂。其早期较易误诊。近年来 ,我们收治 6例。现报告如下 ,并浅谈麻醉体会。一般资料 :本组男 5例 ,女 1例 ;年龄 33～ 6 0岁。 5例为酒后呕吐所致 ,1例为搬重物突然用力时所致。 6例均出现胸及剑突下剧痛 ,伴呼吸困难 ,3例曾误为急腹症。后经胸腔穿刺 ,6例引流液为浅淡血色 ,其中 4例引流液上方有唾液样漂浮物 ,2例经口服美蓝而确诊。治疗 :本组 6例均予急症开胸探查 ,行食管修补或胃造瘘术。此类患者都为饱腹、纵隔气胸、液气胸 ,故手术麻醉难度较大。本组 6例术前均常规用…     

自发性食管破裂7例的诊治体会

目的 总结自发性食管破裂(Boerhaave 综合征) 的诊断和治疗经验,降低病死率.方法 1990-02～2010-12共收治7例由基层医院以液气胸或脓气胸诊断行胸腔闭式引流后转诊患者.所有病例入院后继续行胸腔闭式引流,根据病史、体征及胸腔引流瓶内液体的性状,初步考虑为自发性食管破裂,然后急诊行胸部CT、电子胃镜检查,口服美蓝后根据胸腔引流液的性状得以明确诊断.确诊后均禁食、胃肠减压、抗感染、营养支持、纠正水电解质紊乱及维持酸碱平衡等.急诊手术6例,继续行患侧单纯胸腔闭式引流及支持对症治疗1例.结果 施行急诊手术的6例患者均手术成功,无肺部感染、肺不张、脓胸、食管胸膜瘘、呼吸功能衰竭和心功能衰竭等并发症发生,术后复查胸片显示肺部膨胀良好;施行保守治疗的1例患者,因感染性休克于第5天死亡.结论 尽快做出诊断,早期胸腔闭式引流,及时开胸手术修补、术后充分引流和营养支持是提高治愈率的关键.     

Conservative treatment of spontaneous tracheal rupture

Spontaneous tracheobronchial ruptures are uncommon injuries, especially in the pediatric age group. Tracheal injuries, independent of their origin, may be life-threatening. Here we present the first report of a 14-year-old boy who presented with subcutaneous emphysema, pneumomediastinum, and pneumothorax on day 3, due to spontaneous posterior tracheal-wall rupture following paroxysmal productive coughing. The diagnosis was established using a computed tomography scan of the chest, and tracheobronchoscopy and esophagoscopy under general anesthesia. He was endotracheally intubated and ventilated in the intensive care unit. Such tracheal defects, bridgeable by an endotracheal tube, may permit conservative treatment. The patient was discharged on day 10, and follow-up revealed no late complications.     

Endoscopic ultrasonography for the diagnosis and selecting treatment of esophageal leiomyoma

Background and Aim: To investigate the clinical value of endoscopic ultrasonography (EUS) with miniature ultrasonic probes (MUP) for the diagnosis and treatment of esophageal leiomyoma. Methods: A total of 229 patients with esophageal leiomyoma, diagnosed using EUS, with 12‐MHz MUP and a double‐cavity electronic endoscope, were enrolled. The clinical characteristics of the patients were analyzed, and those who had therapeutic indications received endoscopic resection or surgical excision. Postoperative histological diagnostic results were compared with the preoperative diagnosis of EUS. All patients, including those with or without endoscopic resection or surgical excision were periodically followed up with EUS. Results: Of the 229 patients, 118 received endoscopic resection, and seven received surgical excision. Postoperative histology showed that 110 patients were completely consistent with the preoperative diagnosis of EUS, and the diagnostic accuracy of EUS was 88.6%. No treatment‐related complications occurred among the patients who received endoscopic resection or surgical excision, and no recurrence was observed during the follow‐up examinations. Conclusions: Esophageal leiomyoma is a benign tumor of the esophagus. EUS is a useful technique for the diagnosis of esophageal leiomyoma and for making treatment‐related decisions.     

食管结核的诊断和外科治疗

目的探讨食管结核的临床病理特征、诊断及外科治疗方法。方法分析11例患者的相关临床资料,并分析临床文献。结果男性4例,女性7例;年龄14~62岁,平均47.2岁。症状有吞咽困难和胸骨后疼痛,术前诊断为食管结核2例。误诊9例,分别诊为食管癌7例、食管平滑肌瘤2例。药物治疗2例,手术治疗9例,手术方式包括病灶段食管切除+胃食管吻合术5例、淋巴结切除术2例和胃造瘘术1例,1例术中冰冻切片证实结核而未切除食管,术后无严重并发症发生。11例患者均经病理证实为食管结核,全部治愈,随访1~27年症状均消失,结核无复发。结论食管结核属罕见良性疾病,临床无特异征象,与食管癌和食管良性肿瘤鉴别困难。术前明确诊断后采用药物保守治疗有效,如出现并发症则需外科干预,术后需抗结核治疗12~18月,预后好。     

创伤性膈肌破裂早期诊治探讨

目的探讨影响创伤性膈肌破裂早期诊断和治疗效果的因素。方法对18例创伤性膈肌破裂患者的发病原因、部位、合并伤、诊断经过、手术方法进行回顾分析。结果所有患者均治愈。结论早期诊断及正确的手术方法是提高治愈率及减低并发症的关键。     

Thrombocytopenia and spontaneous rupture of the spleen associated with infectious mononucleosis

Summary Infectious mononucleosis (IM) normally has a benign, self-limiting course. Thrombocytopenia and spontaneous rupture of the spleen are two separate complications of the illness. We describe a patient who suffered from both these complications.     

Distinctive microRNAs in esophageal tumor: early diagnosis,prognosis judgment,and tumor treatment

Esophageal tumor (ET) is aggressive and has poor prognosis. Although the incidence of ET has been reduced by the changing tumor profile, the 5‐year survival and mortality rate of ET has not significantly changed, and the outlook has remained bleak. Therefore, new molecular markers for early diagnosis and prognosis judgment are urgently required. In recent years, tumor has been widely regarded as genetic disease along with epigenetic abnormalities. DNA methylation, histone deacetylation, chromatin remodeling, gene imprinting, and noncoding RNA regulation are the major parts of epigenetic regulation. Mounting evidence exists that miRNAs (microRNA), a class of small, endogenous, and non‐protein‐coding RNAs, provide a novel tool for early clinical diagnosis, prognosis judgment, and gene therapy of ET. In this review, we provide a general overview of the connection between miRNA profiles and their target genes. We also describe in detail in ET from the aspect of clinical insights, the potential application of miRNAs as biomarkers, potential diagnostic and therapeutic tools.     

自发性气胸40例诊断与治疗分析

目的探讨自发性气胸的诊断与治疗。方法对1992～2004年我院收治的自发性气胸40例进行回顾性分析。结果40例自发性气胸患者经保守治疗、抽气、胸腔闭式引流术、胸膜粘连术等综合治疗，效果满意。结论典型的自发型气胸通过病史、体征及辅助检查不难作出正确诊断，但要注意与一些相关疾病鉴别。